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Brain stem External features By Essam eldin AbdelHady Salama Brain stem It is located upon the basal portion of the occipital bone. It is connected to and covered by the cerebellum. It consists of the midbrain, pons, and medulla oblongata. Caudally the medulla is continuous with the spinal cord at foramen magnum. Rostrally the midbrain is continuous with the diencephalon of forebrain. It provides a pathway for tracts running between higher and lower neural centers. Each region is about an inch in length. Dorsal surface Medulla oblongata and pons; Dorsal median sulcus is manifested in the midline of medulla continuous with that of the spinal cord. Dorsal columns in the caudal part of the medulla are formed by fasciculi gracilis and cuneatus, which are continues rostrally from spinal cord to be terminated in gracilis and cuneate tubercles . Dorsal surface The central canal of the spinal cord is continuous in caudal part of medulla (closed medulla). It progresses dorsally until opens out into the 4th ventricle, in the medullary part (open medulla). Dorsal surface The floor of the 4th ventricle forms a rhomboid depression on the dorsal surface of rostral medulla and the dorsal surface of pons. It is widest laterally, forming lateral recesses, at this point lateral apertures (foramen of Lusaka) are present for CSF passage to subarachnoid space. Its lateral walls are made up of Superior and inferior cerebellar peduncles which connecting the brain stem to the cerebellum. It becomes continuous with cerebral aqueduct that passes through the midbrain. Dorsal surface (N.B) Medullary stria ; arcuate fibers to cerebellum dividing the floor of the 4th ventricle into inferior medullary and superior pontine parts. The medullary part contains a triangular depression on each side of the middle lines divides the area into three trigones hypoglossal,vagal, and vestibular. The pontine part contains eminentia medialis for abducent nerve nucleus and facial nerve fibers, the gape between the superior cerebellar peduncles is occupied by the superior medullary valum. Dorsal surface Midbrain; The dorsal aspect of midbrain is marked by 4 paired elevations (superior and inferior colliculi), as parts of visual and auditory systems. The trochlear nerve lies immediately inferior to inferior colliculus . Ventral surface Medulla oblongata; The prominent longitudinal columns (pyramids), that contains the pyramidal or corticospinal tract, lie on either sides of the ventral median fissure. Laterally lie elongated elevations (olive) that contain the inferior olivary nuclei. Inferior cerebellar peduncles lie most laterally. XII nerve rootlets lie in groove between pyramid and olive. IX, X , and XI nerve rootlets lie in groove between olive and Inferior cerebellar peduncles. Ventral surface Pons; The transverse pontine fibers containing pontocerebellar fibers from pontine nuclei to cerebellum via inferior cerebellar peduncle. Groove for basilar artery in the middle line. Middle cerebellar peduncles lie laterally. VI, VII, and VIII emerge between pons and medulla. V nerve emerges midway between upper and lower borders. Ventral surface Midbrain; The massive columns of descending fibers (crus cerebri or bases pedunculi) on each side. The area in between the crus cerebri is the inter peduncular fossa. the inter peduncular fossa contains, 2 mamillary bodies, infundibulum of hypophysis cerebri and posterior perforated substance. III and IV nerves in relation to crus cerebri.